Lost but not forgotten: patients lost to follow-up in a trauma database

To determine the characteristics of patients lost to follow-up and to identify if they are significantly different from those who are followed up in the context of a prospective randomized controlled trial.

A retrospective review of a prospectively acquired trauma database.

A level 1 university-affiliated trauma hospital.

Two hundred and thirty-six patients treated for displaced intra-articular calcaneal fractures between April 1991 and December 1996. Of these, 198 were catcgorized as "attenders" and the remaining 38 were deemed "nonattenders." Demographics, severity of injury, intervention and post-treatment status of the 2 groups were compared. Demographic information, including age, gender, occupation workload, Workers' Compensation Board involvement and other standard trauma information were compared and the differences analyzed.

The nonattenders were younger than the attenders, and there was a significantly increased proportion of Aboriginal Canadians in the nonattenders group. Attenders were more likely to be "skilled or semi-skilled clerical, sales, service or trades crafts" workers, and nonattenders were more likely to be "unskilled clerical, sales, service or labour" workers. Attenders were more likely to have a preoperative Bohler's angle of < 0 degrees, compared with a preoperative Bohler's angle of 0 degrees to 15 degrees for nonattenders.

This trauma population is at higher risk of being marginalized by society and may not have the same accessibility to a study nurse or a hospital contact person. Patients lost to follow-up are a demographically and clinically different patient population from those who remain involved in a long-term prospective trauma study.